Healthcare Provider Details

I. General information

NPI: 1306179593
Provider Name (Legal Business Name): DEON ANDREW GOMES P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 09/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

9340 ALCONA ST
LANHAM MD
20706-2472
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-6533
  • Fax:
Mailing address:
  • Phone: 301-254-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110-003118
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: